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Type of incident:*Skin tear/woundPhysical aggressionVerbal aggression

Where did it happen? HomeCommunity

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NeglectPsychological or emotional abusestealing and financial coercionsInappropriate use of restrictive practiceUnreasonable use of forceUnlawful sexual contact/Inappropriate sexual conductUnexpected deathMissing consumerOther(please provide details):

Other people involved or any witness?InvolvedWitness

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Contacted_Emergency_Services:AmbulanceOther(Please Specify)

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